WWYD

[Iwantvino]

I live abroad. I had my DS 18 months ago and am still traumatised. It ended up in an EMCS due to placenta abruption. I don't really fully understand as none of it was how I have read other childbirth stories. From the very first contraction the pain was too much.... There was none of this walking around, bouncing on balls, eating snacks, even getting up for a wee. The only thing I could do was lie in the bed and wimper.

The thing that was the worst was the fact that there was pain between the contractions. I had read that to deal with a contaction you just had to remember it will stop. But it didn't for me. Don't get me wrong .... The contractions were much more intense but it never stopped.

The only option here for pain relief is an epidural. But even when they had put the maximum dose I was still feeling intense pain during the contractions. The pain in between stopped at least. I had 8 hours before this though.

I never really understood why it was like this. I think I was fully dilated as they were asking whether I needed to push. I didn't realise anything was real wrong until the doctor said there was blood, the baby was in distress and that I needed a EMCS. But why did I not have a build up to the pain? My waters had gone at home and the baby never descended so I guess he could have been in an awkward position. But I've read that an abruption can cause the extreme pain? Has anyone else had this too?

Sorry I've realised this was longer than I anticipated!

So I am now pregnant again and my question is...... Do I opt for an elective or try again? I had an awful recovery last time and was in pain for weeks. I really don't want that with a 2 year old.

I have private health care through my work but last time I went to the local hospital as the doctor who followed me through my pregnancy spoke English. Unfortunately she wasn't working when DS was born. So I could go to a nice private hospital in London but then we have no friends and family who live there. My mum is a carer for my dad so can't come and help with the toddler. Our friends all work. Plus we'd have to rent accomodation in London.

So I could have an elective in London or go to the local hospital here again but then I have the stress of the language, the fact that you don't get options (doctors know best type thing) and the fact it went so horribly wrong last time.

Both options seem pretty awful to be honest. My ideal situation would be to have an easy natural birth and the worst would be a repeat of last time. WWYD? Sorry this was so long!

I don't have an answer to your question - re. what you should do this time around. I think only you can answer that in terms of what you'd be comfortable with and what makes the most sense for you, logistically, as a family.

Re. your last birth. Is there an option to have a 'debrief' where you are? I know the NHS offer this to women who've had traumatic birth experiences. It can help understand why decisions were made, etc.

Re. the contractions. Mine were very much like that with DC1. No breaks between the contractions. It freaked me out as I didn't understand why it was so sodding painful. However, with DC2 they were completely different - much more 'text book' of clear contractions and breaks and they built up more slowly. Overall, I found the contractions much more manageable second time around. There were many other things about my second birth that were different, so I think that just because something happened one way one time it doesn't mean it'll be the same again.

Thanks for answering.

No, there's no option for a debrief. I should have found out more at the time but I just needed to get away from it and not think about it. I do have my discharge notes but they are very brief and just say the reason for the EMCS. I really wish I understood better.

Were you told why your contractions were like the way they were with your first?

I just don't know what's best. London would be so complex and maybe not worth the stress but then we don't have family here and my husband would need to look after the toddler. He stayed at night last time which was needed. I could barely move and he was the one translating. The idea of being in a mess, alone and not bey able to ask for help petrifies me.

Having said everything they did save DS's life. I get the feeling they care for the newborn amazingly but the mother is just left to get on with it. I didn't see a doctor until they discharged me 2 days later.

Ahh it's such a complex decision.

Do doulas exist where you are? You could hire one to be your birth advocate/ partner if your DH might have to look after your toddler.

I think my contractions were like that because I contracted quite quickly. I went from 2cm to baby in about 3 hrs.

Also, have you thought about hypnobirthing or natal hypnotherapy to prepare for this birth? I believe it can help a lot with preparing for birth at the same time as coming to terms with a previous traumatic birth.

Good luck with whatever you decide.

I'm not sure.... Maybe I'll look in to it but then the chances of finding an English speaking one is slim. Plus, it's the two days after the birth they keep you in hospital I'm most worried about.

Poor you having such an intense labour. Least the second was better.

Not really looked in to the hypnobirthing but maybe I should.

It's funny, the stats tell you that the infant and maternal mortality rates are lower here than the UK. It should be better and I should trust them but it was just so awful last time. Then again, I think that would have happened wherever I was. It's just difficult to differentiate between the difference in care and whether I was just unlucky.

Oh and thanks!

I didn't realise how much ds1's birth had affected me until I was pregnant with dc2. Like you I couldn't get a debrief of my previous labour instead I had some counselling which really helped. It helped me talk through what had upset me about my labour and how I could empower myself the second time round and what I would like to happen, given it was possible. I was then able to discuss my fears and what I wanted with my midwife rationally.

Was your first birth uk or abroad?
If UK, I think you need to contact a supervisor of midwives there or consultant for them to go through your notes over the telephone and then ask them what the risks would be this time round. I think it is impossible for you to make an informed choice without knowing the reasons why it happened last time and whether any risks were still present.
If this really isn't an option then I would contact the London hospital and arrange a telephone /Skype appointment and speak to them about it as they can go through the risks with you and give you any recommendations or might even be able to locate your notes so they can see what happened x

First birth was abroad. I do have my notes (strange the patient keeps everything here) but it's very brief. Just says it was a EMCS due to bleeding. I did notice that was anaemic after which might explain the slow recovery?? Doesn't explain the fluid buildup and my wound splitting open mind!

I keep think, yes... London is the best option but then afterwards I'll just want to be home, not in rented accommodation and then my parents (might not be fun as it's a two up two down). Then I think, no, they saved DS's life, it's was horrendous but I survived. Do I really want to be travelling 37+ weeks with a high potential for abruption. From what I've read it has dire consequences if it happens before the labour. At least they monitored me carefully. Then I read a thread about examinations in the UK being optional.... The most certainly not optional here... Very much, just let the doctors get on with it. Then, things like that really don't matter when your baby could have died.

As you can tell, I still don't know what to do and unfortunately I need to book the London option soon if that's what I choose.

Thanks for the replies.

I had a placental abruption with DD and had an EMCS. I also experienced one long pain when labour started and no peaks and troughs with my contractions as I'd been led to believe we're traditional! In my case, the midwife who first examined me said I was having lots and lots of contractions all in a row, which wasn't a good thing. They gave me some drugs to slow things down. To start with they said it was possible I might be able to give birth naturally but we're going to prep me for a C-section "just in case we need to move quickly". Which in the end they did and I was rushed to theatre after another bleed.

I feel I was lucky as my EMCS was fairly quick and not after a long labour, first contraction and first bleed was about 11pm, I was in triage at 1am being examined and DD was out by 4.20am. My recovery from my CS seemed to be not too bad.

I am currently 28 weeks pregnant and just had my consultant's appointment to discuss delivery options and I have opted for an ELCS. I think that recovery is supposed to be better with an ELCS than an EMCS because you haven't been through a trauma or long labour or been up for 24 hours etc. DD will be nearly 3 when I am due (pretty much on her birthday!) and DH is able to take three weeks off to help with her. If she was nearer to 2 then I would be more likely to think more about a VBAC as there is more lifting at that age. How close to 2 is your little one? Does he still need lifting into a cot/highchair etc?

You have been through a very traumatic event. The trauma didn't really register with me until I had a labour debrief when DD was about 18 months.

Sorry this is so long! If I were you I think I would want to be in my home country for the birth so I could get back to my toddler more quickly but it's a hard decision. That said, remember there are no right or wrong answers. What does your gut say? I wanted to take a bit more control which for me was deciding on an Elective. Although I am high risk of this baby coming early so I may well end up with another EMCS!

Oh badger, it's so reassuring to find someone who has been though similar.

I wasn't really aware of problems to be honest. My waters had gone at home just as I was going to bed. I'd been told to go to hospital if that happened but I hated the idea of being there for hours/days before anything happened so I try to go to sleep.... Ha ha. I think my first contraction was about 11. I then tried to wait but was a total mess. I don't like a fuss so didn't wake my husband. Then I noticed there was so blood, not much but some. Then I thought, shit, I don't know if this is normal so went to hospital. They didn't seem concerned immediately.

We weren't aware of bleeding but then they didn't tell us anything . Then I remember bey ask whetting needed to push, no. But then a very slight urge so I did but I think just fluid came out.... It was after this they took me for the EMCS around 9.

My DS will be 2 and 6 days on my due date! Luckily my husband is a stay-at-home dad. I definitely would not have coped for the first 6 weeks last time.

Yesterday I was thinking London. Then this morning I am thinking I will want to he home for the first month or so afterwards, not staying with my parents so here would be the better choice

My gut says that I just want an easy natural but I won't get one wherever I am.

Did they give you any stats about the likelihood of the abruption happening again? What were your reasons for an elective if you don't mind me asking?

It's a really hard thing vino (I would like some vino too)! And I think in a lot of cases the trauma gets forgotten/ignored/put in a box by our brains in the aftermath because there is so much else to deal with like looking after a tiny baby! (And recovering from major surgery). We had feeding issues so that just took over the first four weeks to get DD established on the boob and then you're so sleep deprived for such a long time you're brain's not capable of very much. I didn't really think about what had happened to me until much later. Maybe not until the debrief 18 months later. At the time I was very calm and collected (and just wanted the baby out the quickest way possible) I am much less so now if I think about it properly! Especially as I found out at the debrief that DD was given five resuscitation breaths when she arrived. But it's probably for the best that I didn't know that at the time...

The abruption statistics are actually quite encouraging if you want a VBAC. The chances of one generally happening are something like 5% (that might not be the exact number but it was lowish). Having had a previous abruption only increases that baseline percentage by 1%. The abruption is specific to a pregnancy rather than the mother so there is no need to assume it would happen again.

My consultant was really neutral at my appointment and I am lucky in that my hospital is very pro-choice on deciding VBAC/EMCS. He said there was nothing in my history which made one way riskier than the other for me so it was the mother's choice.

For me the decision making was based on:

1. My recovery from my EMCS was fine. DH went back to work after 2 weeks and I was out of the house (slowly!) the first morning. This time round he can take 3 weeks off. If recovery is longer than anticipated then DD is in nursery three days a week so DH can just take two more days if needed.

1. I only got to 2cm dilated last time so this would be like a first labour and therefore more likely to end with intervention. If I'd got to 8 or 9cm last time I would be more likely to try a VBAC.

1. I'd prefer an active labour if trying that route, walking around, water birth etc. That wouldn't be allowed as I'd be on continual monitoring so not the sort of labour I wanted. If epidural so are the norm in your country then that's probably not a consideration for you.

1. ELCS is a known quantity for me. I'd rather recovery from that surgery than run the risk of forceps/ventouse/third degree tears/incontenance issues... Vaginal births are not as risk free as some consultants would have you believe!!

1. I believe that the recovery from a planned section will be quicker than an EMCS. Two friends who have had them recently after long labours in ending in EMCS last time say it's a very calm procedure, you haven't been up all night, you are advised what to eat/drink before hand and you haven't gone through a long labour first. They both highly recommended them!

1. I believe that VBACs are statistically marginally safer for the mother and ELCS marginally safer for the baby.

1. Only factors for a VBAC for me were, recovery/toddler (but if your DH will be home that would discount this as a factor for me), mother's guilt and would feeding be easier after all the problems we had with DD. But the rational side of me knows that feeding was hard because DD was small, three weeks early and had an undiagnosed tongue tie for 12 weeks so feeding was always going to be hard!

Another essay but I hope it helps! There is a good paper on VBAC vs EMCS which I will see if I can upload somehow.

Funnily enough for me I found out at my consultant's appointment last week that I have a low Papp-A (whatever that is) from my blood results which can be an indicator of placental problems and potential slowing of growth of baby which means they deliver early if it's a problem so I am on extra scans at 28, 32 and 36 weeks. They do electives at 39 weeks here. DD was born at 37 (and I came at 38 weeks and my older brother at 36 weeks) so I don't think I will get to my elective date and will end up with a semi-emergency section!

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/

This is the paper which I thought was interesting (and impartial).

Thanks for sharing badger - really appreciate it.

Fuck, I would be the same as you if I found out about the need for resuscitation.

My EMCS was horrific. I was strapped down and vomiting (a couple of times) and my DH wasn't allowed in. I remember they took DS out and I heard him cry. They then took him away to clean him up etc.. The lovely midwife then came to show me him and put his cheek to mine. He was then taken up to the ward. It took another hour from when he was taken out to being finished. The longest hour of my life!

Then my recovery was slow. I had extra fluid buildup behind the wound which caused the sides to open. I thought it was infected so went back to the hospital where an evil doctor squeezed it to remove the fluid. It was vey painful!

I am coming to realise I was very unlucky! But then exceptionally lucky also as DS is alive.

Sorry to hear about the low Papp-A. In your situation I can totally understand your choice for an elective. Fingers crossed you get your CS efficiently if/when you go in to labour.

Thanks again. Good luck!

Wow, that sounds very traumatic. I must admit mine was fairly calm even when she didn't cry when they took her out (I'd been watching One Born Every Minute so knew they sometimes didn't cry at first!) but after a quick hello to her she and DH were taken away and I was in theatre for another hour as they searched for a secondary source of bleeding due to some old blood, although they didn't find it.

One of the more surreal moments of my life is hearing the surgeons chatting together "Let's take her uterus out and have a look under there". I remember thinking, "hang on, don't I keep that bit?! Oh well, if they are giving me a hysterectomy at least I have a baby!"

Good luck with your decision making. Keep chatting if it helps. We'll be okay one way or another!